Vascular Fellowship Program

Faculty

 Professors

            Richard Gusberg, M.D.

            Bauer E. Sumpio, M.D., Ph.D., Chief

Assistant Professors

           Vivian Gahtan, M.D., Chief VA Vascular Svc

            Sung Kim, M.D.

Clinical Assistant Professors

            Ralph DeNatale, M.D.

            Walter Kwass, M.D.

            Thomas Sweeney, M.D.

Vascular Fellows

1997-99           Georg Steinthorssen, M.D. (Dartmouth)

1998-00           Kathryn Collins, M.D. (Ohio State)

1999-01           Leila Mureebe, M.D. (MCP-Hahnemann)

2000-02           Jose Borromeo, M.D. (St. Luke’s-Roosevelt)

Educational Philosophy and Goals

      The goals of the Yale post-graduate residency  program in General Vascular Surgery encompass the training of vascular surgeons/scientists. Our primary objective is to produce individuals with superior skills in the management of patients with vascular disease. Fundamental to this goal is our commitment to developing the teaching and administrative capabilities of our fellows. As a reflection of our academic mission and our belief that scholarship underscores clinical excellence, we will offer our fellows a broad experience in clinical (and in some cases laboratory) research concerning pertinent issues in vascular surgery, medicine and biology.

 Objectives and Curriculum

      The two teaching hospitals that will form the basis for the vascular surgery fellowship are Yale-New Haven Hospital (YNHH) and the Veterans Administration of Connecticut (VA). The core surgical program which supports this fellowship is the Yale General Surgery Residency. This program provides rotations in vascular surgery to all general surgery residents at the PGY-1 (2 months), PGY-2 (4 months), PGY-3 (3 months), PGY-4 (3 months) and PGY-5 (3 months) levels. There is great opportunity at both hospitals for clinical training and research involvement at the fellow level. This involvement will certainly enhance, rather than detract from, the overall vascular surgery educational environment available to general surgery trainees.

    More than 750 vascular cases were performed at YNHH from 1998-99 and the fellow was involved in 223  cases with a wide variety of routine and complex vascular reconstructions (37 aneurysms, 40 carotid, 73 infrainguinal bypass, 15 visceral reconstructions).

    The vascular surgery fellowship is two years. The first year is clinical and the second year will be customized to the goals of the vascular fellow including research, training in endovascular techniques, and/or noninvasive vascular testing.

    The overall aim is to provide clinically-focused, excellent training of one fellow each year. It is also the expectation of the program that a significant portion of  clinical trainees will pursue a career in  academic  vascular surgery, armed with the clinical, teaching, research and leadership skills to be successful.  

Fellow Clinical Responsibility

    The fellow will spend the majority of time running the YNHH vascular service with a PGY-4 resident and junior residents. The PGY-5 (Chief Resident) will run the VA vascular service. At the VA, the PGY-4 and PGY-5 share every other night on-call from home.  The second-year vascular fellow will  be available to assist with the unusual and more technically demanding vascular procedures at the VA (e.g., re-do carotid and aortic procedures, complex visceral artery reconstructions). The fellow will be responsible for post-operative care of patients that he operates on at the VA.

    The weekly educational conferences for students, residents and attendings are the shared responsibility of the vascular fellows with the research fellow responsible for the Teaching Conference and the clinical fellow for M&M and Preoperative Conference (Monday 4:00-6:00 PM).  The clinical fellow will run daily teaching afternoon rounds at YNHH with the residents, as well as discussions of vascular issues with medical students in their third and fourth year. The fellow will participate in all quality assurance and administrative meetings and will present at least one nursing in-service each month.  

Institutional Support

    The hospital support services at YNHH, and the VA include ward secretaries on every floor, who are responsible for the organization and maintenance of the patients' charts including laboratory data, scheduling laboratory tests, etc.  There is a blood drawing and an IV team at all hospitals.  The nurses start most of the routine intravenous fluids.  There is a patient support team which includes transport and orderly services on every service. All hospitals are totally computerized such that all orders, laboratory data and so forth are carried out through the computer system.

    There are six on-call rooms at YNHH assigned to the General Surgical Service.  Each of the specialty services has its own on-call room, which is available to the General Surgical resident rotating through.  At the VA on-call rooms, mostly with bathrooms, are assigned to the surgical housestaff. They have 24 hour access to the library and MEDLINE CD-ROM.  They receive meals free on call.

  Facilities and Equipment

     The entire Vascular Surgical Service, aside from the academic and ambulatory care facilities, is housed within YNHH, thereby integrating the various services and facilitating the care of patients by the resident staff. The university outpatient facility is located in the Yale Physicians Building and the attending and resident clinics are staffed on the third floor. There is a non-invasive vascular laboratory on site on the third floor with capabilities for Duplex studies, PVRs, transcutaneous oximetry and OPGs and staffed by two registered vascular technologists. The vascular fellow will get “hands-on” training with intra-operative and out-patient Duplex scanning.

     At YNHH, a dedicated OR suite is equipped with modern up-to-date instruments, including angioscopy, and imaging studies. There are 25 beds on the surgical floor, 7-5, that is utilized by both the Vascular and Transplant service with overflows to the neighboring General Surgical Units. There are 12 beds in the Surgical ICU for use by the vascular service with overflow to the adjoining Neuro,  CT or Medical ICU.

  Research Programs

    Productive and prominent programs in both basic and clinical research are fundamental to the development of clinical excellence and our academic mission. Our Vascular Biology Laboratory, under the direction of Dr. Bauer Sumpio, has both national and international visibility and is well‑funded through NIH, AHA, and VA sources. This vigorous research program, focusing on delineating molecular events in the arterial wall in response to mechanical forces, has involvement by students, residents, visiting fellows, as well as faculty. Dr. Gahtan has expanded our vascular biology program to the VA hospital. Her research program is centered around the regulation of smooth muscle cell migration and proliferation by the extracellular matrix. Her laboratory is currently focused on the role of thrombospondin-1 in influencing smooth muscle cell phenotype and is funded through VA and AHA sources. Dr. Kim’s research objectives are to understand the molecular mechanism mediating the effect of estrogen (genomic and non-genomic) on vascular cells exposed to mechanical forces and on vascular cell migration.  Dr. Gusberg’s clinical research program is focused on predicting and assessing outcomes (neuro-psychological impact of carotid endarterectomy, predicting blood pressure and functional response to renal revascularization, defining costs vs. benefits of re-do infrainguinal bypass surgery, evaluating functional and quality of life outcomes in patients undergoing elective abdominal aortic aneurysm repair).

    Our clinical research programs are enhanced by the inter-disciplinary collaboration that has developed in our Vascular Center. Ongoing clinical research projects include: the impact of diabetes (and its control) on vascular disease (and its treatment); multidisciplinary approach to complex diabetic foot wounds including microvascular reconstruction; abdominal aortic aneurysms (natural history/VA cooperative trial); use of duplex scanning for intraoperative assessment; claudication trials (OPC28326); diabetic ulcer study (Regranex); infrainguinal graft trial (Impra Distaflo); and endovascular stent-graft trials (World Medical Medtronic Talent Aortic Graft, Gore Thoracic Excluder).